Innere Medizin (Heidelberg, Germany)最新文献

A 63-year-old woman presented with a 5-day history of high-grade fever, petechiae on the lower legs and severe thrombocytopenia. Clinical findings included left inguinal lymphadenopathy and an encrusted wound on the left tibia, which the patient had sustained from a rotten piece of wood. Her pet dog had sporadically licked the wound. After more than 2 days of blood culture incubation, Capnocytophaga canimorsus was finally detected. Antibiotic treatment with amoxicillin/clavulanic acid led to a complete recovery.

We report two cases of primary hyperparathyroidism first diagnosed during pregnancy due to severe complications of hypercalcemia. Imaging revealed parathyroid adenomas, which were surgically removed. Early interdisciplinary diagnosis and management are essential to reduce maternal and fetal risks and ensure favorable outcomes.

A 55-year-old female patient presented to the authors' clinic with acute pain in the fingers of the right hand. Clinically, oscillography and duplex sonography suggested a diagnosis of acral embolism. Arterial occlusions in the right hand were confirmed by angiography. After several hours of thrombolytic therapy, arterial blood flow in the right hand was significantly improved. During further diagnostic workup, a colon carcinoma was diagnosed and treated with hemicolectomy and adjuvant chemotherapy. In summary, the patient had a paraneoplastic peripheral embolism.

Older adults with frailty show an increased vulnerability to suffer negative health events, e.g., in the context of adverse drug reactions. Owing to the complex clinical needs of this population, older adults with frailty should receive a focused medication management. The consensus principles for clinical practice developed by the Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network may offer guidance in this respect. These principles emphasize the importance of consolidated medication lists, of considering the individual's medication management capacity, and of appropriate prescribing practices. Numerous medications may adversely affect several geriatric syndromes. To date, the body of evidence with regard to the pharmacotherapy of frail individuals is still limited. In recent years, there have been increasing efforts to retrospectively identify older adults with frailty in randomized controlled trials, e.g., by applying the frailty index according to Rockwood. The analysis of routine healthcare data offers an additional approach to generate evidence on pharmacotherapy in frail older individuals.

Background: Patients with hypertension or dyslipidemia and patients in cardiovascular secondary protection usually require more pharmaceuticals to achieve the target values. For some years, a combination treatment with a single pill has been recommended for arterial hypertension and for most patients even from the beginning of treatment.

Objective and methods: The aim of this review article is to present the current recommendations and illuminate the evidence with respect to cardiovascular outcomes for single pill treatment in comparison to loose combinations.

Results: The achievement of the target values in arterial hypertension, dyslipidemia and in secondary prevention is insufficient. Poor adherence plays a major role in this. This greatly depends on the number of pills, a simple treatment schedule and as few treatment changes as possible. For this reason, national and international scientific societies recommend an initial combination treatment when possible in a single pill. This concept is supported by a broad evidence base for an improved adherence. There are now also investigations that show significant reductions in cardiovascular outcomes, including the overall mortality, for single pill treatment in comparison to the use of the same substances in identical doses in the form of loose combinations. Simultaneously, the use of a single pill leads to a reduction of the total treatment costs due to improved adherence, a lower number of hospitalizations and a reduction of cardiovascular outcomes. The implementation of the recommended concept is insufficient as combinations are still used for the majority of patients, contrary to the guidelines and despite the availability of single pills with the selected substances and doses.

Conclusion: The use of single pills in cardiovascular treatment improves the adherence, reduces cardiovascular outcomes and is widely recommended by specialist societies. The improvement of the insufficient implementation in the clinical practice needs comprehensive efforts.

Frailty is a common geriatric syndrome in older patients with cancer. It affects prognosis and treatment tolerance in various ways. Frailty and cancer share several common risk factors, which are reflected in the hallmarks of aging. An oncogeriatric assessment with management (GAME) provides the opportunity to detect frailty and its related geriatric impairments and offers the possibility to compensate for frailty-associated vulnerability. Thus, higher-grade treatment-associated toxicities of the provided oncological treatments are reduced. Furthermore, treatment completion rates and quality of life can be improved by GAME. The following review article provides an overview of the general definition of physical and social frailty, its significance in oncology, and the evidence for GAME. Lastly, first study results of frailty-adapted treatment approaches are summarized.